Background
Implications for mental health services and client outcomes
Methods
Design
Setting
Sample
Eligibility Criteria
Sample selection and procedures
Pre-Recruitment
Recruitment
Selection
Procedures
Instruments
Trauma/PTSD
Administration
Client measures
CM measures
Preparation
Data analysis
Statistical analysis
Results and discussion
Attrition
Response rate
Data
Demographics: client
Variable | PTSD n = 9 | Trauma/no PTSD n = 11 | No Lifetime Trauma n = 7 |
---|---|---|---|
Gender M/F | 5/4 | 5/6 | 4/3 |
Mean Age | 34(SD = 12.2) | 39(SD = 11) | 37(SD = 14) |
Country of Birth | |||
Australia | 5 | 9 | 6 |
Indigenous | 0 | 0 | 0 |
Overseas | 4 | 2 | 1 |
Highest educational level | |||
Completed Secondary -Junior Level | 5 | 4 | 4 |
Completed Secondary- Senior Level | 3 | 6 | 1 |
Tertiary | 1 | 1 | 2 |
Marital status | |||
Single never married | 7 | 7 | 4 |
Married | 1 | 2 | 1 |
Divorced/Separated | 1 | 2 | 1 |
Widowed | 0 | 0 | 1 |
Employment Status | |||
Employed | 3 | 0 | 1 |
Unemployed | 5 | 11 | 4 |
Student | 1 | 0 | 0 |
Homemaker | 0 | 0 | 2 |
Main Source of Income | |||
Government Payment | 8 | 11 | 6 |
Private | 1 | 0 | 1 |
Primary Diagnostic Profile | |||
Schizophrenia – various types | 4 | 7 | 5 |
Borderline Personality Disorder | 4 | 1 | 0 |
Depression | 1 | 1 | 1 |
Bipolar Affective Disorder | 0 | 2 | 1 |
Mean age of onset for primary diagnosis | 25(SD = 12.5) | 25(SD = 11.2) | 25 (SD= 7.9) |
Dual Diagnosis (co-occurrence substance misuse) | 7 | 5 | 1 |
Mean number years with Tx service | 5 (SD= 3.4) | 8 (SD= 3.2) | 8 (SD= 2.6) |
Persons subject to involuntary mental health order at time of study | 0 | 1 | 3 |
Mean number recorded contacts with CM over 12 months | 29 (SD = 7) n = 5 | 21 (SD7.5) n = 7 | 33 (9) n = 5 |
Mean time in hours of contacts | 17.5(SD= 6.5) | 13(SD = 6.3) | 14.6(SD = 3.2) |
TRAUMATIC EVENT | PTSD N = 9 | NO PTSD N = 11 | ||
---|---|---|---|---|
No. | % | No. | % | |
Serious Accident, fire or explosion | 7 | 78% | 4 | 36% |
Natural disaster | 1 | 11% | 0 | |
Non-sexual assault – family member or someone known | 6 | 67% | 4 | 36% |
Non-sexual assault – stranger | 3 | 33% | 3 | 27% |
Sexual assault – family member or someone known | 5 | 55.5% | 3 | 27% |
Sexual assault – stranger | 3 | 33% | 2 | 18% |
Military combat/war zone | 1 | 11% | 1 | 9% |
Sexual contact under 18 years with someone 5 or more years older | 7 | 78% | 4 | 36% |
Imprisonment | 3 | 33% | 2 | 18% |
Torture | 1 | 11% | 0 | |
Life-threatening Illness | 4 | 44% | 2 | 18% |
Other type of event | 4 | 44% | 7 | 63% |
Co-Morbidity levels
Demographics: case manager (n = 17)
Discussion: client demographics
Levels of employment
Primary psychiatric diagnosis
Data: trauma/PTSD profile
Rates of trauma and PTSD n = 27
Please note
Number of events (n = 20)
PTSD group (n = 9)
Non- PTSD group (n = 11)
Type of event
SYMPTOM CLUSTER | PTSD GROUP N = 9 | NON-PTSD GROUP N = 11 |
---|---|---|
B: Re-experiencing | ||
Upsetting thoughts or images | 55.5% (5) | 9.1 %(1) |
Bad dreams or nightmares | 55.5% (5) | 0 |
Reliving the traumatic event | 44.4% (4) | 18.2% (2) |
Feeling emotionally upset when reminded of the event | 66.6% (6) | 36.4% (4) |
Experiencing physical reactions when reminded of the event | 33.3% (3) | 27.3% (3) |
C: Avoidance
| ||
Trying not to think, talk, or have feelings about the event | 66.6% (6) | 9.1 %(1) |
Trying to avoid activities, places or people that recall the event | 55.5% (5) | 0 |
Unable to remember important part of the event | 11.1%(1) | 9.1 %(1) |
Having less interest in important activities | 66.6% (6) | 9.1 %(1) |
Feeling distant or cut-off from people | 77.8% (7) | 36.4% (4) |
Feeling emotionally numb | 44.4% (4) | 27.3% (3) |
Feeling that future plans will not come true | 44.40/0 (4) | 27.3% (3) |
D: Arousal
| ||
Having trouble sleeping | 33.3% (3) | 18.2% (2) |
Feeling irritable | 66.6% (6) | 27.3% (3) |
Having trouble concentrating | 55.5% (5) | 27.3% (3) |
Being overly alert | 55.5% (5) | 27.3% (3) |
Being jumpy or easily startled | 44.40/0 (4) | 9.1 %(1) |
CLUSTER ITEM | NUMBER IN |
MEAN
|
SD
|
P*
| ||
---|---|---|---|---|---|---|
Lower 50% | Upper 50% | |||||
PTSD
| ||||||
Re-experiencing (B)
| ||||||
Number of symptoms Md: ≤ 3 |
Yes
|
2
|
7
|
3.67
|
1.41
| |
No | 6 | 5 | 2.18 | 1.94 | 0.072 | |
Severity score Md: 4.5 |
Yes
|
3
|
6
|
7.11
|
4.43
| |
No |
7
| 4 | 3.36 | 3.04 |
0.038
| |
Avoidance (C)
| ||||||
Number of symptoms Md: 3.5 |
Yes
|
2
|
7
|
5.11
|
1.36
| |
No | 8 | 3 | 3.00 | 2.10 |
0.018
| |
Severity score Md: 6.5 |
Yes
|
3
|
6
|
10.78
|
5.43
| |
No | 7 | 4 | 4.82 | 4.19 |
0.013
| |
Hyper-arousal (D)
| ||||||
Number of symptoms Md: ≤ 3 |
Yes
|
5
|
4
|
3.78
|
1.20
| |
No | 8 | 3 | 2.27 | 1.74 |
0.041
| |
Severity score Md: 4.0 |
Yes
|
4
|
5
|
7.78
|
4.66
| |
No | 6 | 5 | 4.60 | 3.66 | 0.115 | |
Total number of symptoms endorsed Md: <14.5
|
Yes
|
2
|
7
|
12.67
|
3.39
| |
No | 8 | 3 | 7.18 | 5.72 |
0.021
| |
Total symptom severity score Md: 9.5
|
Yes
|
3
|
6
|
25.67
|
13.77
| |
No | 7 | 4 | 12.36 | 9.60 |
0.020
|
PTSD group n = 9
Trauma with the most effect
Symptom profile
Symptomatology specifiers (E criterion)
Impairment of functioning (F criterion)
PTSD group n = 9
Non- PTSD group n = 11
Discussion: trauma/PTSD profile
Chronicity of trauma
Multi-traumatisation
Types of traumatic events
Symptom profile
Rates of PTSD
Potential contributory factors to the higher rates of trauma and PTSD found in clients of mainstream psychiatric services
Age and type of trauma
Gender effects
The Psychiatric setting
Substance use and misuse
Implications of these contributing factors for CMHS and mainstream psychiatry
The interaction of PTSD and other mental illness
Co-morbidity and PTSD
Data: effect of PTSD diagnosis on client outcome
Domain | Study Group: Client Data | Population 'Norms' Psychosis n = 173 | Australian Population n = 396 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
M | SD | P | Effect size (Eta2) |
M
| SD |
P* | M | SD |
P* | |
Physiological Health
| 60.7 | 15.4 | 80 | 17.1 | ||||||
PTSD n = 5
|
37.14
| 8.60 |
.034
| 0.26 |
.004
|
.0005
| ||||
No PTSD n = 12 | 59.22 | 20.17 | .805 |
.004
| ||||||
Psychological Health
| 56.8 | 17.4 | 72.6 | 14.2 | ||||||
PTSD
|
32.50
| 9.50 |
.010
| 0.36 |
.005
|
.001
| ||||
No PTSD | 58.33 | 18.37 | .778 | .021 | ||||||
Social Relationships
| 51.3 | 20.3 | 72.2 | 18.5 | ||||||
PTSD
|
38.33
| 26.74 | .527 | .339 |
.047
| |||||
No PTSD | 45.13 | 16.46 | .221 |
.0005
| ||||||
Environment
| 61.1 | 13.8 | 74.8 | 13.7 | ||||||
PTSD
|
50.62
| 10.22 |
.015
| 0.33 | .084 |
.006
| ||||
No PTSD | 69.72 | 13.57 | .061 | .186 |
Domain | Study Group: CM Data | Psychosis 'Norms' | |||||
---|---|---|---|---|---|---|---|
P* | |||||||
M
|
SD
|
P
| Effect size (Eta2) |
M
|
SD
| ||
Physiological Health
|
57
|
12.5
|
.110
| ||||
PTSD n = 5
|
38.75
| 20.10 |
.001
| ||||
No PTSD n = 12 | 70.23 | 11.82 | |||||
Psychological Health
|
51
|
13.0
|
.032
| ||||
PTSD
|
36.66
| 9.94 |
.007
| ||||
NO PTSD | 54.16 | 10.87 | |||||
Social Relationships
|
43.4
|
18.8
|
.026
| ||||
PTSD
|
26.66
| 10.86 | .066 | ||||
No PTSD | 40.97 | 14.41 | |||||
Environment
|
55.4
|
13.5
|
.178
| ||||
PTSD
|
46.87
| 11.69 |
.006
| ||||
No PTSD | 65.62 | 10.74 |